- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,884.03 / $6,025.60
| Facility | | $2,041.74 | $2,884.03 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,467.37 / $8,128.31
| Professional | | $1,995.26 | $3,467.37 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $17,378.01
| Facility | | $3,388.44 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,235.94 / $5,495.41
| Professional | | $2,137.96 | $3,235.94 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,165.95 / $17,378.01
| Facility | | $1,737.80 | $6,165.95 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,388.44 / $7,762.47
| Professional | | $2,041.74 | $3,388.44 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,162.28 / $10,232.93
| Facility | | $870.96 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,570.40 / $4,677.35
| Professional | | $1,949.84 | $2,570.40 | $4,677.35 |